Please fill out the Stop Smoking Questionnaire below.

Your answers will provide me with valuable information about your smoking habits, thought processes and beliefs that have tended to keep you smoking until now. I will use this information to have a great understanding of what needs to change to free you from smoking most easily. Please add to your smoking questionnaire any information that you think might be relevant and useful. Once you've finished, click SUBMIT and your form will come straight through to me. Many thanks! 

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Hypnotherapy Directory? Google search? Recommendation? Please do mention as it helps me a lot Thanks!
If yes, please describe: who was it with? What for? Did you think you were Hypnotised?
You can select multiple options
What do you like about it? What needs has it been meeting?
On an aeroplane? On the underground? When swimming? etc....
If so, please detail
If yes, please detail
Eg: Chest pain, Sickness, Rotten smell, Headache, Nausea, Felt Disgusted, Someone else looked terrible, etc.......
Please give ALL reasons
(Eg: quit a job, ended a relationship, moved house, decided to take a course/ change courses, etc....)
You will find this half way down Booking page